Let’s close the gaps on food fortification – for better nutrition

Over a quarter of the global population, more than two billion people, suffer micronutrient deficiency – also known as hidden hunger. This restricts growth and wellbeing, restricts children’s potential and slows economic progress.

Fortification of staple foods with essential vitamins and minerals is a proven, cost-effective and sustainable way of reaching large numbers of people with vital nutrients. Large-scale fortification involves adding small amounts of vitamins and minerals to widely consumed foods and condiments. Fortifying salt with iodine, for example, prevents irreversible brain damage in young children, while fortifying flour with iron and folic acid helps protect against iron deficiency anaemia, a major cause of maternal death, and neural tube defects, respectively.

Fortification works

The evidence confirms that food fortification programmes in low- and middle-income countries improve a range of micronutrient deficiency-related outcomes. Large-scale food fortification has substantially increased the availability of nutrients – including iron, folate and vitamin A – in several regions globally.

The most striking success story is that of salt iodisation. Over six billion people consume iodised salt. It is credited with preventing 750 million cases of goitre over the past 25 years.

In 2013, GAIN developed the Fortification Assessment Coverage Toolkit (FACT) to generate much-needed information on the coverage and quality of fortified foods. Between 2013 and 2017, FACT surveys were conducted in 16 low- and middle-income countries.

The results have revealed that while in many places food fortification has high potential to reach vulnerable populations (including women and young children, those living in rural areas and those living in poverty), this potential is not presently met, owing to poor programme coverage and compliance.

The use gap represents the proportion of households in a population not consuming the food vehicle chosen for fortification. This gap highlights the extent to which foods that are widely consumed have been selected for inclusion in a programme.

The feasibility gap highlights the difference between the proportion of households consuming the food in any form and those consuming the food in a fortifiable and industrially produced form (that is, the potential proportion of households that could be reached by the programme if all fortifiable food was fortified.) This gap highlights the extent to which the programme was well designed, meaning it selected foods to fortify based on those that are used in a fortifiable form by a high proportion of households.

The fortification gap represents the difference between the proportion of households that consume the fortifiable food and those that consume it fortified. This gap highlights one element of effective implementation.

A fourth gap, not shown, can also be identified. This is the quality gap – the extent to which any fortified food consumed is fortified to national standards. Where these gaps are large, greater monitoring and enforcement may be needed.

Let’s close the gaps

Donors, industry, national governments, consumers and civil society all have roles to play – in funding, compliance, monitoring, and in holding those responsible to account. Estimates suggest another $150–250 million from donors is required before 2030 to complete the food fortification agenda.

Sustainable Development Goal 2 aims for the end of hunger and malnutrition for all by 2030 – closing the gaps on food fortification is essential to the success of this effort.